Platelet-to-White Blood Cell Ratio Is Associated with Adverse Outcomes in Cirrhotic Patients with Acute Deterioration

Jung Hee Kim, Sung Eun Kim, Do Seon Song, Hee Yeon Kim, Eileen L. Yoon, Tae Hyung Kim, Young Kul Jung, Ki Tae Suk, Baek Gyu Jun, Hyung Joon Yim, Jung Hyun Kwon, Sung Won Lee, Seong Hee Kang, Moon Young Kim, Soung Won Jeong, Jae Young Jang, Jeong Ju Yoo, Sang Gyune Kim, Young Joo Jin, Gab Jin CheonByung Seok Kim, Yeon Seok Seo, Hyung Su Kim, Dong Hyun Sinn, Woo Jin Chung, Hwi Young Kim, Han Ah Lee, Seung Woo Nam, In Hee Kim, Jung Il Suh, Ji Hoon Kim, Hee Bok Chae, Joo Hyun Sohn, Ju Yeon Cho, Yoon Jun Kim, Jin Mo Yang, Jung Gil Park, Won Kim, Hyun Chin Cho, Dong Joon Kim

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6 Scopus citations


Background: The platelet-to-white blood cell ratio (PWR) is a hematologic marker of the systemic inflammatory response. Recently, the PWR was revealed to have a role as an independent prognostic factor for mortality in patients with hepatitis B virus (HBV)-related acute-on-chronic failure (ACLF) and HBV-related liver cirrhosis (LC) with acute decompensation (AD). However, the prognostic role of the PWR still needs to be investigated in LC patients with AD. In this study, we analyzed whether the PWR could stratify the risk of adverse outcomes (death or liver transplantation (LT)) in these patients. Methods: A prospective cohort of 1670 patients with AD of liver cirrhosis ((age: 55.2 ± 7.8, male = 1226 (73.4%)) was enrolled and evaluated for 28-day and overall adverse outcomes. Results: During a median follow-up of 8.0 months (range, 1.9–15.5 months), 424 (25.4%) patients had adverse outcomes (death = 377, LT = 47). The most common etiology of LC was alcohol use (69.7%). The adverse outcome rate was higher for patients with a PWR ≤ 12.1 than for those with a PWR > 12.1. A lower PWR level was a prognostic factor for 28-day adverse outcomes (PWR: hazard ratio 1.707, p = 0.034) when adjusted for the etiology of cirrhosis, infection, ACLF, and the MELD score. In the subgroup analysis, the PWR level stratified the risk of 28-day adverse outcomes regardless of the presence of ACLF or the main form of AD but not for those with bacterial infection. Conclusions: A lower PWR level was associated with 28-day adverse outcomes, indicating that the PWR level can be a useful and simple tool for stratifying the risk of 28-day adverse outcomes in LC patients with AD.

Original languageEnglish
Article number2463
JournalJournal of Clinical Medicine
Issue number9
StatePublished - 1 May 2022

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© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • acute decompensation
  • acute-on-chronic liver failure
  • adverse outcomes
  • liver cirrhosis
  • platelet-to-white blood cell ratio


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